European Urology Today: June/July 2023

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Case study No. 76 This 62-year-old lady has been suffering from multiple sclerosis for many years from which she has a spastic tetraplegia and is confined to a wheelchair. She also has been suffering from neurogenic bladder and neurogenic bowel disorders. For many years the bladder was treated by indwelling catheters and has a small capacity. The bowel disorder led to many episodes of ileus and numerous surgical procedures including an extensive large bowel resection with a terminal colostomy of the ascending colon in the left abdomen. In addition there have been several laparotomies for adhesions. A baclofen pump has been inserted in the right abdominal wall. After years of indwelling catheter treatment she now has developed muscle invasive bladder cancer (squamous cell differentiation).

very wide (Fig. 4 ). A buccal mucosa graft is harvested (Fig. 5), defatted (Fig. 6) and allows ventral closure of the urethra (Fig. 7). Spongial suture over the graft (Fig. 8) will get it vascularized. A urethral catheter is placed and removed 3 weeks later, after the urethrogram demonstrates a normal urethral lumen with no fistulation.

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Discussion point: • Which management and treatment is advisable?

Case provided by Prof. Oliver Hakenberg Dept. of Urology, University Hospital Rostock, Germany. E-mail:

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European Urology Today June/July 2023


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